Expressive Language Disorder Research Articles

Management of communication disorders: a clinical perspective

This paper examines the role of Clinical Psychologist in the management of Communication Disorders (CDs). Clinical Psychologist applies the science of psychology to clinical problems and is actively engaged in teaching, research, and clinical assessment and management of several disorders, for example behavioural, emotional and mental disorders. An increasing body of evidence demonstrates that psychological factors are key components in the cause of CDs; therefore, needless to say, Clinical Psychologist is actively involved in the assessment and management of CDs. CDs refer to the inability to receive, send, process, and compare verbal or nonverbal behaviour. And it may be evident in the processes of hearing, language, and/or speech and may range in severity from mild to profound. Clinical populations such as individuals with Aphasia, Autism, Cleft lip and palate, Expressive and receptive language disorders, Hearing impairment, Intellectual disability, Specific learning disorders, stuttering etc., show one or the other kind of problems in speech and language. In this paper, I would discuss the psychological aspects and management of various CDs and conclude by suggesting the importance of psychological intervention in conjunction with other approaches/therapies such as speech and language therapy.

Need and Perspectives of Internet-based Interventions for Common Specific language Disorders and Connected Specific Learning Disabilities in Childhood and Youth

Abstract In the last century medical progress has substantially reduced the morbidity and mortality in somatic diseases. However there is a “new morbidity” with an increase of psychomotor developmental, learning, behavioral and mental disorders often with an initial onset in about 20% of childhood. A social gradient in terms of health inequalities is known. Reducing this new morbidity of child and adolescent health problems is a major public health priority. In this context alternative, complementary strategies for prevention or treatment are needed. At the example of expressive language disorder and consecutive risks in developing a specific reading and writing disability we would like to discuss in this survey potential future preventional perspectives.

Emisiones otoacústicas como analizador de la función coclear en niños con problemas de lenguaje

Introduction and objectivesSpeech perception that takes place in the cochlea is involved in the process of language. The objective was to describe the findings in transient otoacoustic emissions in children with language problems before and after 6 months of speech therapy. MethodsThere were 17 children with language problems between 3 and 6 years of age diagnosed with anarthric language delay (expressive and mixed language disorder). They underwent medical history, otoscopy, intelligence level testing, initial language test, tympanometry of 226Hz, audiometry and transient otoacoustic emission test. ResultsWe evaluated the 17 patients again after 6 months of attending speech therapy. The percentage of overall reproducibility of transient otoacoustic emissions in both ears was adequate to perform frequency analysis. We found a statistically significant difference (P≤0.01) in the frequency of 1kHz reproducibility when comparing results before and after therapy in the right ear. There was a significant difference (P≤0.05) when comparing the results of audiometry at frequencies of 0.5, 1.5, 2, 4 and 8kHz in the right ear and a highly significant difference (P=0.001) in the frequency of 3kHz in the left ear. ConclusionsThe analysis of sound through the cochlea is involved in the process of language acquisition. A poor processing of speech sounds in the peripheral system could result in poor processing at the central level. Consequently, it is important to consider our results when making a diagnosis and carrying out rehabilitation treatment in children with language disorders.

The Cognitive and Behavioral Phenotype of the 16p11.2 Deletion in a Clinically Ascertained Population

BackgroundDeletion of the recurrent ~600 kb BP4-BP5 chromosomal region 16p11.2 has been associated with a wide range of neurodevelopmental outcomes. MethodsTo clarify the phenotype of 16p11.2 deletion, we examined the psychiatric and developmental presentation of predominantly clinically referred individuals, with a particular emphasis on broader autism phenotype characteristics in individuals with recurrent ~600 kb chromosome 16p11.2 deletions. Using an extensive standardized assessment battery across three clinical sites, 85 individuals with the 16p11.2 deletion and 153 familial control subjects were evaluated for symptom presentation and clinical diagnosis. ResultsIndividuals with the 16p11.2 deletion presented with a high frequency of psychiatric and developmental disorders (>90%). The most commonly diagnosed conditions were developmental coordination disorder, phonologic processing disorder, expressive and receptive language disorders (71% of individuals >3 years old with a speech and language–related disorder), and autism spectrum disorder. Individuals with the 16p11.2 deletion not meeting diagnostic criteria for autism spectrum disorder had a significantly higher prevalence of autism-related characteristics compared with the familial noncarrier control group. Individuals with the 16p11.2 deletion had a range of intellectual ability, but IQ scores were 26 points lower than noncarrier family members on average. ConclusionsClinically referred individuals with the 16p11.2 deletion have high rates of psychiatric and developmental disorders and provide a genetically well-defined group to study the emergence of developmental difficulties, particularly associated with the broader autism phenotype.

Inter-word variability of Hungarian affricates /ʦ, ʧ/ in the speech of monolingual children with and without language disorders

This study focuses on the characteristics of inter-word variability (IWV) with respect to two Hungarian affricates (/ʦ, ʧ/) produced by children with typical language development (children with TD) aged 3;0–5;11, and those with primary expressive language disorders (children with LD) with the mean age of 6;7. IWV is described in terms of frequency of occurrence, the segments realised in place of the targets and the error patterns resulting in variable production. Findings revealed that variability is characteristic of the production of /ʧ/ in younger children with TD, and of both affricates in children with LD. Beside some similarities, children with TD and those with LD differed from each other in the way in which variable productions emerged. Children with TD committed errors typical of their age, and their IWV mostly reflected developmental changes. Children with LD, however, demonstrated some indicators of phonological disorders such as the persistence of normal simplifications and chronological mismatch.

Answers to Your DSM-5 Questions

Answers to Your DSM-5 Questions

Sensorimotor function in preschool-aged children with expressive language disorder

The aim of the study was to evaluate functional motor performance and haptic object recognition in 5-year-old children with mild expressive language disorder (ELD) in comparison with age- and gender-matched healthy children. The subjects were classified by speech-language pathologist using The Reynell Developmental Language Scales III and Boehm Test of Basic Concepts: Preschool as children with mild ELD (n=29, incl. 23 boys and 6 girls) and children with typical language development as controls (n=29, incl. 23 boys and 6 girls). The children were examined for manual dexterity, ball skills, static and dynamic balance by Movement-ABC, haptic object recognition (HOR), hand-grip strength (HGS) and vertical jumping performance. Children with mild ELD demonstrated significantly higher scores (i.e., inferior performance) in all subtests of M-ABC (all p values <0.05), in haptic object recognition (p<0.01) and vertical jumping height (p<0.05) compared to controls. However, no statistically significant differences (p>0.05) emerged from HGS. Boys with mild ELD demonstrated higher results in impairment score (p<0.001), ball skills (p<0.01) and balance (p<0.01) of M-ABC, as well as in HOR (p<0.05). Girls with mild ELD showed higher impairment score (p<0.05) with lower percentile (p<0.05) in M-ABC, indicating inferior motor performance, and lower HGS for the non-dominant hand (p<0.05). Seven out of 29 (24.1%) children with mild ELD had definite or borderline motor difficulties, while only one child in control group (3.4%) demonstrated borderline motor difficulties. Children with mild expressive language disorder do not perform as well as controls in tests of functional motor skills, but their results in tests demanding maximal muscle force generation are in level with typically developing children. Boys and girls with mild ELD demonstrated higher impairment scores in M-ABC, indicating the need to follow their overall development more closely.

Health related quality of life in parents of children with speech and hearing impairment

ObjectivesHearing impairment and specific language disorder are two entities that seriously affect language acquisition in children and reduce their communication skills. These children require specific treatment and higher levels of care than healthy children. Their language abilities also strongly influence parent–child interactions. The purpose of our study was to evaluate the health-related quality of life (HRQOL) of the parents of hearing-impaired children and the parents of children with speech difficulties (specific language disorder). MethodsOur study subjects included 349 parents (182 mothers and 167 fathers) of preschool-aged children with receptive expressive language disorder and 131 parents (71 mothers and 60 fathers) of children with severe hearing impairment. A control group was composed of 146 parents (82 mothers and 64 fathers) of healthy children of the same age. HRQOL was assessed using the SF-36 questionnaire. ResultsFor all groups of parents, the mothers had poorer scores compared with the fathers, but large differences were apparent depending on the child's impairment. In the control group, the scores of the mothers were significantly lower than the fathers’ scores in only two (of eight) health domains. In contrast, the scores were lower in three domains for the mothers of speech-impaired children and in six domains for the mothers of hearing-impaired children, representing the greatest difference between the parents. When compared with the control group, both the mothers and fathers of speech-impaired children scored significantly worse in five health domains. Fathers of hearing-impaired children scored significantly worse than controls in three health domains. The lowest scores, indicating the poorest HRQOL, were observed for mothers of hearing-impaired children, who obtained significantly lower scores than the control mothers in all health domains except the emotional role. ConclusionsThe parents of preschool-aged speech-and hearing-impaired children experience poorer HRQOL than parents of healthy children of the same age. Mothers of hearing-impaired children are especially affected, demonstrating a negative impact in almost all health domains.

Small intragenic deletion in FOXP2 associated with childhood apraxia of speech and dysarthria

Relatively little is known about the neurobiological basis of speech disorders although genetic determinants are increasingly recognized. The first gene for primary speech disorder was FOXP2, identified in a large, informative family with verbal and oral dyspraxia. Subsequently, many de novo and familial cases with a severe speech disorder associated with FOXP2 mutations have been reported. These mutations include sequencing alterations, translocations, uniparental disomy, and genomic copy number variants. We studied eight probands with speech disorder and their families. Family members were phenotyped using a comprehensive assessment of speech, oral motor function, language, literacy skills, and cognition. Coding regions of FOXP2 were screened to identify novel variants. Segregation of the variant was determined in the probands' families. Variants were identified in two probands. One child with severe motor speech disorder had a small de novo intragenic FOXP2 deletion. His phenotype included features of childhood apraxia of speech and dysarthria, oral motor dyspraxia, receptive and expressive language disorder, and literacy difficulties. The other variant was found in a family in two of three family members with stuttering, and also in the mother with oral motor impairment. This variant was considered a benign polymorphism as it was predicted to be non-pathogenic with in silico tools and found in database controls. This is the first report of a small intragenic deletion of FOXP2 that is likely to be the cause of severe motor speech disorder associated with language and literacy problems.

DSM-5Provides New Take on Neurodevelopment Disorders

The chapter on neurodevel­opmental disorders comes first in DSM-5’s diagnostic section, reflecting a lifespan approach to the manual’s organization. See end of article for supplemental information.

Poster Presentations Wednesday 23 January 2013

Objective: To describe neurological outcomes with aggressive immune-modulatory therapy, including rituximab in two cases of anti–N-methyl-D-aspartate receptor (NMDAR- Ab) encephalitis. Background: Up to 40% of NMDAR-Ab encephalitis presents in children and adolescents. It can result in significant acute and chronic neurological morbidity with a risk of death. Aggressive immune therapy has been suggested but no consensus exists on treatment protocols. Results: Case 1: A 7-year-old girl, presented with a cluster of focal epileptic seizures evolving into bilateral convulsive movements. MRI was normal. EEG was consistent with a genetic generalised epilepsy. She represented 2 months later with seizures, orofacial dyskinesia, poor memory, severe ag itation and insomnia. Neu ro psychological findings showed severe receptive and expressive lan guage disorder, low Perceptual Reasoning IQ and slowed Processing Speed (PS). NMDAR-Ab were positive. Methylpred- nisolone and IVIG were given concomitantly. Within 3 weeks she received rituximab with subsequent marked improvement in behaviour, cognition and PS 4 weeks post treatment. At 1 year sheisseizure-freewithnorelapses. Case 2: Following 2 weeks of intermittent aggression and headaches, a 14 year old girl presented with aphasia and a cluster of focal epileptic seizures. Over 3–4 days she developed orofacial dyskinesia, intermittent agitation with a complex hyperkinetic movement disorder and autonomic instability. MRI was normal, EEG encephalopathic. NMDAR-Ab were positive. She was trea- ted concomitantly with methylprednisolone and IVIG. In week two she had plasmapheresis and in week three rituximab. Herneurology improved dramatically with normal speech and behav iour at 6 weeks. Initial neuropsychological results indicated severe receptive and expressive language disorder with low scores on the WISC-IV and the Children’s Memory Scale. Conclusion: In two patients with NMDAR-Ab encephalitis early aggressive immunotherapy including rituximab resulted in rapid resolution of neurological and behavioural signs. Neuropsycho logical deficits have improved but not resolved at short term fol low up.

Speech and language delay in two children: an unusual presentation of hyperthyroidism

Hyperthyroidism is rare in pre-school children. Untreated, it can have a profound effect on normal growth and development, particularly in the first 2 years of life. Although neurological manifestations of dysthyroid states are well known, specific expressive speech and language disorder as a presentation of hyperthyroidism is rarely documented. Case reports of two children with hyperthyroidism presenting with speech and language delay. We report two pre-school children with hyperthyroidism, who presented with expressive speech and language delay, and demonstrated a significant improvement in their language skills following treatment with anti-thyroid medication. Hyperthyroidism must be considered in all children presenting with speech and language difficulties, particularly expressive speech delay. Prompt recognition and early treatment are likely to improve outcome.

¿Puede el CCC-2 diferenciar perfiles pragmáticos?

Objective: The current study aims to check the ability of the Spanish translation of the Children´s Communication Checklist-2 (CCC-2) to discriminate and identify pragmatic profiles. Method: A normative profile of the instrument was performed on a 100 Spanish-speaking sample. To determinate to what extend the Spanish translation of the CCC-2 is able to discriminate between children with a pragmatic language disorder and an expressive language disorder a comparison was made between 10 subjects with an Asperger syndrome and 10 subjects with Down syndrome versus a Control group. Results: The Spanish translation of the CCC-2 is able to identify pragmatic profiles and to discriminate between normative and clinic profiles as Asperger syndrome and Down syndrome. Furthermore, this instrument is able to obtain a quantitative profile picture of the communication impairments of those children.

¿Puede el CCC-2 diferenciar perfiles pragmáticos?

Objective: The current study aims to check the ability of the Spanish translation of the Children´s Communication Checklist-2 (CCC-2) to discriminate and identify pragmatic profiles. Method: A normative profile of the instrument was performed on a 100 Spanish-speaking sample. To determinate to what extend the Spanish translation of the CCC-2 is able to discriminate between children with a pragmatic language disorder and an expressive language disorder a comparison was made between 10 subjects with an Asperger syndrome and 10 subjects with Down syndrome versus a Control group. Results: The Spanish translation of the CCC-2 is able to identify pragmatic profiles and to discriminate between normative and clinic profiles as Asperger syndrome and Down syndrome. Furthermore, this instrument is able to obtain a quantitative profile picture of the communication impairments of those children.

Anomalies électroencéphalographiques paroxystiques et troubles spécifiques du langage de l’enfant : vers un modèle neurodéveloppemental ?

Specific language impairment (SLI) is a primary developmental disorder in which language is significantly more impaired than other developmental domains. Abnormal electroencephalographic recordings without clinical seizures are often observed. The aim of this retrospective study was to characterize the frequency of these abnormalities, to describe them and to analyze their association with anamnestic, clinical, paraclinical and evolution characteristics. The cases of 35 children with a diagnosis of SLI, who also underwent electroencephalography and MRI, were systematically reviewed retrospectively. In this population, aged between 4 and 7 years, 49% (n=17) of patients exhibited a specific expressive language disorder and 51% (n=18) a specific receptive disorder. Forty-nine percent of the children featured abnormal electroencephalography results. Abnormalities were essentially localized on the left side of the brain and in two specific regions: the temporo-occipital (60%) and the frontorolandic (30%) regions. The groups with and without abnormalities were compared statistically with each other in terms of clinical, paraclinical and evolution characteristics. Evolution data were available for 24 patients through a telephone interview and for nine patients through a new complete language evaluation.The comparison of the two groups showed significant differences in terms of severity of the phonological disorder, a higher number of delayed acquisition of walking and cleanliness and a higher range of non specific psychomotor difficulties. A large proportion of children suffering from SLI present abnormal electroencephalography recordings with no clinical seizures. This rate is much higher than in the general population and the abnormalities are essentially localized on the left side of the brain in regions known for their specific role in language development. These abnormalities are more frequent in children with a severe phonological disorder, suggesting that they may share common pathophysiological features with SLI. The presence of EEG abnormalities in a large group of patients suffering from SLI associated with minor neurological abnormalities suggests a possible theoretical neurodevelopmental model. Minor neurodevelopmental abnormalities, genetically transmitted or acquired during the pre- or perinatal period, may create vulnerability towards SLI. This vulnerability, in conjunction with environmental influences such as family environment, linguistic stimuli, exposure to multiple languages, or transitory hearing loss, might take the form of SLI. This hypothesis underlines the importance of prevention and early detection of SLI when identifying vulnerable subjects. Monitoring the family early through parental guidance and early school support would facilitate the acquisition of language.

Children With 7q11.23 Duplication Syndrome: Speech, Language, Cognitive, and Behavioral Characteristics and Their Implications for Intervention

7q11.23 duplication syndrome is a recently-documented genetic disorder associated with severe speech delay, language delay, a characteristic facies, hypotonia, developmental delay, and social anxiety. Developmentally appropriate nonverbal pragmatic abilities are demonstrated in socially comfortable situations. Motor speech disorder (Childhood Apraxia of Speech and/or dysarthria), oral apraxia, and/or phonological disorder or symptoms of these disorders are common as are characteristics consistent with expressive language disorder. Intensive speech/language therapy is critical for maximizing long-term outcomes.

The validity of psychiatric diagnoses: The case of ‘specific’ developmental disorders

We tested whether developmental coordination disorder (DCD) and mixed receptive expressive language disorder (RELD) are valid diagnoses by assessing whether they are separated from each other, from other childhood disorders, and from normality by natural boundaries termed zones of rarity. Standardized measures of intelligence, language, motor skills, social cognition, and executive functioning were administered to children with DCD (n = 22), RELD (n = 30), autistic disorder (n = 30), mental retardation (n = 24), attention deficit/hyperactivity disorder (n = 53) and to a representative sample of children (n = 449). Discriminant function scores were used to test whether there were zones of rarity between the DCD, RELD, and other groups. DCD and RELD were reliably distinguishable only from the mental retardation group. Cluster and latent class analyses both resulted in only two clusters or classes being identified, one consisting mainly of typical children and the other of children with a disorder. Fifty percent of children in the DCD group and 20% in the RELD group were clustered with typical children. There was no evidence of zones of rarity between disorders. Rather, with the exception of mental retardation, the results imply there are no natural boundaries between disorders or between disorders and normality.

The most common type of FTLD-FUS (aFTLD-U) is associated with a distinct clinical form of frontotemporal dementia but is not related to mutations in the FUS gene

Frontotemporal lobar degeneration (FTLD) is clinically, pathologically and genetically heterogeneous. Recent descriptions of a pathological sub-type that is ubiquitin positive, TDP-43 negative and immunostains positive for the Fused in Sarcoma protein (FUS) raises the question whether it is associated with a distinct clinical phenotype identifiable on clinical grounds, and whether mutations in the Fused in Sarcoma gene (FUS) might also be associated with FTLD. Examination of a pathological series of 118 cases of FTLD from two centres, showing tau-negative, ubiquitin-positive pathology, revealed FUS pathology in five patients, four classified as atypical FTLD with ubiquitin inclusions (aFTLD-U), and one as neuronal intermediate filament inclusion disease (NIFID). The aFTLD-U cases had youthful onset (22-46years), an absence of strong family history, a behavioural syndrome consistent with frontotemporal dementia (FTD) and severe caudate atrophy. Their cognitive/behavioural profile was distinct, characterised by prominent obsessionality, repetitive behaviours and rituals, social withdrawal and lack of engagement, hyperorality with pica, and marked stimulus-bound behaviour including utilisation behaviour. They conformed to the rare behavioural sub-type of FTD identified previously by us as the "stereotypic" form, and linked to striatal pathology. Cognitive evaluation revealed executive deficits in keeping with subcortical-frontal dysfunction, but no cortical deficits in language, perceptuospatial skills or praxis. The patient with NIFID was older and exhibited aphasia and dyspraxia. No patient had clinical evidence of motor neurone disease during life, or a mutation in the FUS gene. In the complementary clinical study of 312 patients with clinical syndromes of FTLD, genetic analysis revealed a 6bp deletion in FUS in 3 patients, of questionable significance. One presented a prototypical picture of FTD, another expressive language disorder, and the third semantic dementia. None showed the early onset age or distinctive 'stereotypic' picture of patients with aFTLD-U. We conclude that aFTLD-U is associated with a distinct clinical form of frontotemporal dementia, potentially allowing identification of such patients in life with a high degree of precision. Whether mutations in the FUS gene cause some cases of FTLD remains unresolved.

Landau–Kleffner syndrome: A rare Auditory Processing Disorder: Series of cases and review of the literature

Objective To describe the clinical presentation and treatment of 3 children with an Auditory Processing Disorder with an identifiable neurological cause: Landau–Kleffner syndrome [3]. This classical syndrome is well recognized in pediatric neurology but the diagnosis is less well known to Pediatric Otolaryngology, Speech Language Pathology and Audiology services. Methods Retrospective chart review of three patients with Landau–Kleffner syndrome. Results In all cases, pharmacological intervention led to clinical and electroencephalographic improvement, but all patients had long-term difficulty with understanding sounds in a noisy environment. Magnetic Resonance Imaging (MRI) of the brain was normal in all three patients. Their language disturbance improved over time. Speech language intervention was helpful in addressing communication difficulties arising from the auditory processing/receptive and expressive language disorder. Conclusion A multidisciplinary assessment is the key for early diagnosis, treatment and follow-up in patients with this syndrome.

Substance Use Disorders: Findings from a Longitudinal Study of Individuals with and without a History of Developmental Language Disorders

Objective: To study the prevalence and types of substance use disorders (SUDs) in adults diagnosed during childhood as having a developmental language disorder (DLD). Patients and Methods: The prevalence rates and types of SUDs in a clinical sample of 469 individuals diagnosed during childhood as having a DLD were compared with SUDs in 2,345 matched controls from the general population without a known history of DLD using data from the nationwide Danish Psychiatric Central Register (DPCR). The average observation time was 34.7 years, and the mean age at follow-up was 35.8 years. Results:Of the 469 individuals with DLD, 12 (2.6%) appeared in the DPCR with an SUD diagnosis, compared with 46 (2.0%) in the control group (p = 0.41; OR 1.3; 95% CI 0.7–2.5). Specific SUDs occurred with a low frequency in both groups. Only cocaine-related disorders were significantly associated with DLD (p = 0.03). Variables at assessment in childhood, i.e. gender, IQ, the presence of a receptive language disorder, and the degrees of receptive and expressive language disorders were not associated with an SUD diagnosis in the DPCR at follow-up. Conclusion: Our findings do not support the hypothesis that DLD is a risk factor for SUD in adulthood.